Sajid looked quite bemused when I started talking to him about smoking cessation. ‘I had been using five bags of heroin a day, doc, so I think that’s the least of my worries,’ he said.
I think it is fair to say that over the years that has been the fairly typical response to my questions on smoking, and that probably includes the attitude of many a key worker as well. I’ve said many times that GPs do not ask patients about alcohol often enough, as for some it reflects on their own behaviour. The same, it could be said, applies to keyworkers and smoking questions.
As well as improving physical health, there is evidence that those who do also stop smoking are moreover less likely to relapse to illicit drug use. It is also one of the most effective interventions we have when working with cannabis users.
So, I persisted with Sajid: he was 38, had smoked cigarettes since the age of 13 and heroin since he was 25 – with a fair bit of crack along the way as well. We have recently invested in mini spirometers at our practice and using one of these I was able to show him that he had a lung age of 60, meaning his lung function was equivalent to that of a 60-year-old man.
It was suggestive of chronic obstructive pulmonary disease (COPD). I was able to explain that COPD is increasingly the cause of death for those who use illicit drugs as they get into middle age, and that cigarette smoking was a key component of this.
I have come across people who have been through drug treatment and have been discharged, but who haven’t had their smoking addressed and therefore sadly remain at risk of significant respiratory disease.
In working with clients or patients we cannot downplay the significance of the impact of smoking on health, wellbeing and recovery, and we must encourage them to stop even if we are smokers ourselves.
In the next edition of our popular Network newsletter (look out for it this month) we are pleased to include an article on current pilots to address smoking in people who use drugs and alcohol, as well as an article on brief interventions for problematic cannabis use.
Steve Brinksman is a GP in Birmingham and clinical lead of SMMGP,
. He is also the RCGP regional lead in substance misuse for the West Midlands.